Postoperative Nausea and Vomiting After Craniotomy: An Evidence-based Review of General Considerations, Risk Factors, and Management

Alberto A Uribe, Nicoleta Stoicea, Marco Echeverria-Villalobos, Alexandre B Todeschini, Alan Esparza Gutierrez, Antonia R Folea, Sergio D Bergese, Alberto A Uribe, Nicoleta Stoicea, Marco Echeverria-Villalobos, Alexandre B Todeschini, Alan Esparza Gutierrez, Antonia R Folea, Sergio D Bergese

Abstract

One of the most common and distressing symptoms after craniotomy is postoperative nausea and vomiting (PONV). PONV could generate delayed postanesthesia care and hospitalization discharge, lower patient satisfaction, and an increase in overall hospitalization costs. The incidence of reported PONV after craniotomy is 22% to 70% without prophylaxis, and a multimodal regimen of medication has been recommended. We conducted a comprehensive literature review of the clinical evidence related to PONV prevention and management after craniotomy. All clinical trials in adult populations relevant to PONV after craniotomy available in English language and indexed in PubMed, Google Scholar and Cochrane Library databases from January 1997 up to September 2018 were retrieved using a combination of free-text words related to PONV in craniotomy. After screening manuscripts identified in the initial search, 23 clinical trials investigating systemic pharmacological intervention versus placebo or active control in patients undergoing craniotomy under general anesthesia met the criteria for inclusion in this comprehensive narrative review. The pathophysiology and mechanisms of PONV after craniotomy could be multifactorial in etiology. Therefore, based on current evidence, PONV management after craniotomy should focus on perioperative patient assessment, surgical, and anesthesia-related risk factors and the selection of systemic pharmacological considerations to reduce its incidence and complications. A multimodal regimen of medication targeting different chemoreceptors in the vomiting center is recommended. Ondansetron and dexamethasone, or their combination, are the most frequently used and effective agents. Further randomized clinical trials comparing different regimens that significantly reduce the incidence of PONV in craniotomy would provide relevant evidence-based data for PONV management in this patient population.

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1
FIGURE 1
Flowchart diagram of manuscript selection. n indicates number of manuscripts.

References

    1. Popugaev KA, Lubnin AY. Wartenberg KE, Shukri K, Abdelhak T. Postoperative care in neurooncology. Neurointensive Care. Cham, Switzerland: Springer; 2015:95–123.
    1. Johnson WC, Seifi A. Trends of the neurosurgical economy in the United States. J Clin Neurosci. 2018;53:20–26.
    1. Cowan JA, Jr, Chandler WF. Changing trends in the use and costs of procedures performed by neurosurgeons in the United States. Clin Neurosurg. 2007;54:209–211.
    1. Eberhart LH, Morin AM, Kranke P, et al. . Prevention and control of postoperative nausea and vomiting in post-craniotomy patients. Best Pract Res Clin Anaesthesiol. 2007;21:575–593.
    1. Gan TJ, Diemunsch P, Habib AS, et al. . Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118:85–113.
    1. Sinha PK, Koshy T, Gayatri P, et al. . Anesthesia for awake craniotomy: a retrospective study. Neurol India. 2007;55:376–381.
    1. Fabling JM, Gan TJ, El-Moalem HE, et al. . A randomized, double-blinded comparison of ondansetron, droperidol, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. Anesth Analg. 2000;91:358–361.
    1. Fabling JM, Gan TJ, El-Moalem HE, et al. . A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy. J Neurosurg Anesthesiol. 2002;14:102–107.
    1. Wang YJ, Cheng ZG, Guo QL. Clinical observation of granisetron in preventing postoperative nausea and vomiting following supratentorial craniotomy. Hunan Yi Ke Da Xue Xue Bao. 2002;27:545–546.
    1. Madenoglu H, Yildiz K, Dogru K, et al. . Randomized, double-blinded comparison of tropisetron and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. J Neurosurg Anesthesiol. 2003;15:82–86.
    1. Hartsell T, Long D, Kirsch JR. The efficacy of postoperative ondansetron (Zofran) orally disintegrating tablets for preventing nausea and vomiting after acoustic neuroma surgery. Anesth Analg. 2005;101:1492–1496.
    1. Wig J, Chandrashekharappa KN, Yaddanapudi LN, et al. . Effect of prophylactic ondansetron on postoperative nausea and vomiting in patients on preoperative steroids undergoing craniotomy for supratentorial tumors. J Neurosurg Anesthesiol. 2007;19:239–242.
    1. Gupta P, Sabharwal N, Kale S, et al. . Granisetron versus ondansetron for post-operative nausea and vomiting prophylaxis in elective craniotomies for brain tumors: a randomized controlled double-blind study. Anesth Essays Res. 2014;8:72–77.
    1. Sinha PK, Tripathi M, Ambesh SP. Efficacy of ondansetron in prophylaxis of postoperative nausea and vomiting in patients following infratentorial surgery: a placebo-controlled prospective double-blind study. J Neurosurg Anesthesiol. 1999;11:6–10.
    1. Kathirvel S, Dash HH, Bhatia A, et al. . Effect of prophylactic ondansetron on postoperative nausea and vomiting after elective craniotomy. J Neurosurg Anesthesiol. 2001;13:207–212.
    1. Jellish WS, Leonetti JP, Sawicki K, et al. . Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery. Otolaryngol Head Neck Surg. 2006;135:175–181.
    1. Jain V, Mitra JK, Rath GP, et al. . A randomized, double-blinded comparison of ondansetron, granisetron, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. J Neurosurg Anesthesiol. 2009;21:226–230.
    1. Habib AS, Keifer JC, Borel CO, et al. . A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy. Anesth Analg. 2011;112:813–818.
    1. Latz B, Mordhorst C, Kerz T, et al. . Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors. J Neurosurg. 2011;114:491–496.
    1. Ryu JH, Lee JE, Lim YJ, et al. . A prospective, randomized, double-blind, and multicenter trial of prophylactic effects of ramosetronon postoperative nausea and vomiting (PONV) after craniotomy: comparison with ondansetron. BMC Anesthesiol. 2014;14:63.
    1. Tsutsumi YM, Kakuta N, Soga T, et al. . The effects of intravenous fosaprepitant and ondansetron for the prevention of postoperative nausea and vomiting in neurosurgery patients: a prospective, randomized, double-blinded study. Biomed Res Int. 2014;2014:307025.
    1. Bergese SD, Antor MA, Uribe AA, et al. . Triple therapy with scopolamine, ondansetron, and dexamethasone for prevention of postoperative nausea and vomiting in moderate to high-risk patients undergoing craniotomy under general anesthesia: a pilot study. Front Med. 2015;2:40.
    1. Ha SH, Kim H, Ju HM, et al. . Comparison of the antiemetic effect of ramosetron with ondansetron in patients undergoing microvascular decompression with retromastoid craniotomy: a preliminary report. Korean J Anesthesiol. 2015;68:386–391.
    1. Nilsson I, Karlsson A, Lindgren L, et al. . The efficacy of P6 acupressure with sea-band in reducing postoperative nausea and vomiting in patients undergoing craniotomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol. 2015;27:42–50.
    1. Bergese SD, Puente EG, Antor MA, et al. . The effect of a combination treatment using palonosetron, promethazine, and dexamethasone on the prophylaxis of postoperative nausea and vomiting and qtc interval duration in patients undergoing craniotomy under general anesthesia: a pilot study. Front Med. 2016;3:1.
    1. Bergese SD, Puente EG, Antor MA, et al. . A prospective, randomized, double-blinded, double-dummy pilot study to assess the preemptive effect of triple therapy with aprepitant, dexamethasone, and promethazine versus ondansetron, dexamethasone and promethazine on reducing the incidence of postoperative nausea and vomiting experienced by patients undergoing craniotomy under general anesthesia. Front Med. 2016;3:29.
    1. Apfel CC, Heidrich FM, Jukar-Rao S, et al. . Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109:742–753.
    1. Fabling JM, Gan TJ, Guy J, et al. . Postoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy. J Neurosurg Anesthesiol. 1997;9:308–312.
    1. Lonjaret L, Guyonnet M, Berard E, et al. . Postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med. 2017;36:213–218.
    1. Jangra K, Kumari K, Panda NB, et al. . Postoperative nausea and vomiting in neurosurgical patients: current concepts and management. Neurol India. 2018;66:1117–1123.
    1. Andrews PL. Physiology of nausea and vomiting. Br J Anaesth. 1992;69(suppl 1):2S–19S.
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
    1. Iqbal IM, Spencer R. Postoperative nausea and vomiting. Anaesth Intens Care Med. 2012;13:613–616.
    1. Horn CC, Wallisch WJ, Homanics GE, et al. . Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014;722:55–66.
    1. Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesiaa review. Anesthesiology. 2003;98:530–547.
    1. Pusch F, Berger A, Wilding E, et al. . Preoperative orthostatic dysfunction is associated with an increased incidence of postoperative nausea and vomiting. Anesthesiology. 2002;96:1381–1385.
    1. Gan TJ, Mythen MG, Glass PSA. Intraoperative gut hypoperfusion may be a risk factor for postoperative nausea and vomiting. Br J Anaesth. 1997;78:476.
    1. Apfel CC, Laara E, Koivuranta M, et al. . A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700.
    1. Dewinter G, Staelens W, Veef E, et al. . Simplified algorithm for the prevention of postoperative nausea and vomiting: a before-and-after study. Br J Anaesth. 2018;120:156–163.
    1. Apfel CC, Kranke P, Eberhart LH. Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia. 2004;59:1078–1082.
    1. Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand. 2002;46:921–928.
    1. Meng L, Quinlan JJ. Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves. J Neurosurg Anesthesiol. 2006;18:235–239.
    1. Sato K, Sai S, Adachi T. Is microvascular decompression surgery a high risk for postoperative nausea and vomiting in patients undergoing craniotomy? J Anesth. 2013;27:725–730.
    1. Tan C, Ries CR, Mayson K, et al. . Indication for surgery and the risk of postoperative nausea and vomiting after craniotomy: a case-control study. J Neurosurg Anesthesiol. 2012;24:325–330.
    1. Flynn BC, Nemergut EC. Postoperative nausea and vomiting and pain after transsphenoidal surgery: a review of 877 patients. Anesth Analg. 2006;103:162–167.
    1. Chowdhury T, Prabhakar H, Bithal PK, et al. . Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi J Anaesth. 2014;8:335–341.
    1. Chui J, Mariappan R, Mehta J, et al. . Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis. Can J Anaesth. 2014;61:347–356.
    1. Cheng CR, Sessler DI, Apfel CC. Does neostigmine administration produce a clinically important increase in postoperative nausea and vomiting? Anesth Analg. 2005;101:1349–1355.
    1. Tramer MR, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. Br J Anaesth. 1999;82:379–386.
    1. Gupta A, Dwivedi Y, Saxena S, et al. . A randomized control study of dexmedetomidine versus fentanyl as an anesthetic adjuvant in supratentorial craniotomies. Anaesth Pain Intens Care. 2017;21:306–311.
    1. Peng K, Jin XH, Liu SL, et al. . Effect of intraoperative dexmedetomidine on post-craniotomy pain. Clin Ther. 2015;37:1114.e1–1121.e1.
    1. Manninen PH, Tan TK. Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia. J Clin Anesth. 2002;14:279–283.
    1. Eseonu CI, Rincon-Torroella J, ReFaey K, et al. . Awake craniotomy vs craniotomy under general anesthesia for perirolandic gliomas: evaluating perioperative complications and extent of resection. Neurosurgery. 2017;81:481–489.
    1. Ouyang M, McDonagh DL, Phillips-Bute B, et al. . Does midline shift predict postoperative nausea in brain tumor patients undergoing awake craniotomy? A retrospective analysis. Curr Med Res Opin. 2013;29:1033–1038.
    1. Akcil EF, Dilmen OK, Vehid H, et al. . Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clin Neurol Neurosurg. 2017;154:98–103.
    1. Hwang JY, Bang JS, Oh CW, et al. . Effect of scalp blocks with levobupivacaine on recovery profiles after craniotomy for aneurysm clipping: a randomized, double-blind, and controlled study. World Neurosurg. 2015;83:108–113.
    1. Tsaousi GG, Pourzitaki C, Bilotta F. Prophylaxis of postoperative complications after craniotomy. Curr Opin Anaesthesiol. 2017;30:534–539.
    1. Atsuta J, Inoue S, Tanaka Y, et al. . Fosaprepitant versus droperidol for prevention of PONV in craniotomy: a randomized double-blind study. J Anesth. 2017;31:82–88.
    1. Xu M, Zhou SJ, Jiang CC, et al. . The effects of P6 electrical acustimulation on postoperative nausea and vomiting in patients after infratentorial craniotomy. J Neurosurg Anesthesiol. 2012;24:312–316.
    1. Stoicea N, Gan TJ, Joseph N, et al. . Alternative therapies for the prevention of postoperative nausea and vomiting. Front Med. 2015;2:87.
    1. Asmussen S, Maybauer DM, Chen JD, et al. . Effects of acupuncture in anesthesia for craniotomy: a meta-analysis. J Neurosurg Anesthesiol. 2017;29:219–227.
    1. Antor MA, Uribe AA, Erminy-Falcon N, et al. . The effect of transdermal scopolamine for the prevention of postoperative nausea and vomiting. Front Pharmacol. 2014;5:55.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel